Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Obstetrics and Gynecology, KKR Sapporo Medical Center, Sapporo, Japan.
J Obstet Gynaecol Res. 2022 Dec;48(12):3209-3218. doi: 10.1111/jog.15432. Epub 2022 Sep 29.
This study examines patterns and predictors of site-specific recurrence to explore the causes of local recurrence of cervical cancer.
Radical hysterectomy was performed in 121 patients (stage IB-IIB). Nerve-sparing was performed whenever possible. The first recurrence in local, regional, and distant areas was examined. We investigated the possibility of nerve involvement in local recurrence, focusing on paravaginal tissues containing the pelvic plexus. We provide Supporting Information on local recurrence in the paravaginal area.
Local recurrence was an independent event from regional or distant recurrence. Local recurrence was seen only in high-risk patients, while regional and distant recurrences were not or less related to the risk category. The independent risk factors by logistic regression for local, regional, and distant recurrence were parametrial invasion, vaginal invasion, and lymph node metastasis, respectively. Local recurrence showed a comparable or more significant negative impact on survival than distant recurrence. Among seven patients with local recurrences, five had a recurrence in the paravagina. The rate of paravaginal recurrence was one in 76 early-stage and four in 45 locally advanced diseases. Four sites of paravaginal recurrence occurred on the nerve-sparing side and two on the non-nerve-sparing side. Supporting Information demonstrated histological evidence of perineural spread into the pelvic plexus and perineural invasion of the primary tumor.
A high percentage of local recurrences are in paravaginal tissue containing the pelvic plexus. The causal association of nerve-sparing surgery and perineural invasion with local recurrence needs to be investigated in large prospective studies.
本研究旨在探讨宫颈癌局部复发的模式和预测因素，以探究局部复发的原因。
对 121 例（IB-IIB 期）患者行根治性子宫切除术。只要有可能，就进行神经保留术。检查局部、区域和远处的首次复发情况。我们研究了神经受累与局部复发的关系，重点关注包含盆腔丛的阴道旁组织。我们提供了关于阴道旁区域局部复发的支持性信息。
局部复发是独立于区域或远处复发的事件。局部复发仅见于高危患者，而区域和远处复发与风险类别无关或相关性较小。局部、区域和远处复发的独立危险因素分别为宫旁侵犯、阴道侵犯和淋巴结转移。局部复发对生存的影响与远处复发相当或更显著。在 7 例局部复发患者中，5 例复发于阴道旁。阴道旁复发的发生率为 76 例早期疾病的 1/7 和 45 例局部晚期疾病的 1/4。阴道旁复发的 4 个部位发生在神经保留侧，2 个发生在非神经保留侧。支持性信息显示了肿瘤原发灶神经周围扩散和神经浸润进入盆腔丛的组织学证据。
很大比例的局部复发发生在包含盆腔丛的阴道旁组织中。需要在大型前瞻性研究中调查神经保留手术和神经周围侵犯与局部复发的因果关系。
